Advanced practice, role development and
health policy Problem set study Exam
Questions and Correct Answers Guaranteed
Success 2023/2024
3rd party payers - correct answer
-private insurer reimbursement is contract specific per state
insurance commission
-Civilian Health and Medical Program of the US (military
personnel)
-Federal Employee health Benefit Program
Methods of payment for APRN - correct answer
1. Fee-for-service model
2. Episodic model
3. Capitation model, PPO, and HMO
Fee-for-service model - correct answer -unit of payment by visit
or procedure
-can occur with utilization review in which case payer has right
to authorize or deny payment of expensive medical interventions
(hospital admission, extra hospital days, surgery)
Episodic model - correct answer -one sum is paid for all services
delivered during a given illness
-DRG fee payment
,Professional Organization purpose and benefits - correct
answer -establish practice standards
-collective voice to promote nursing and quality of care
-monitor and influence policy and legislative initiatives
-position papers on practice issues
-disseminate information
Use or research in practice settings - correct answer -use EBP
-translate clinical evidence into practice settings and with
practice issues
-develop research-based clinical pathways
-track clinical outcomes and variances
-demonstrate quality and cost-effectiveness of care
-give structure to demonstration projections
-persuade lawmakers of NP value
-improve quality and patient outcomes
Barriers to research utilization - correct answer -time and cost
of studies
-resistance to change in work setting
-lack of rewards for using research findings
-lack of understanding or uncertainty regarding research
outcomes
Healthy People 2020 - correct answer 1. General health status
-life expectancy
,-healthy life expectancy
-physical and mental unhealthy days
-self-assessed health status
-limitation of activity
-chronic disease prevalence
-international comparisons
2. Disparities and inequality
-race/ethnicity
-gender
-SES
-LGBTQ
-geography
3. Social determinants of health
-social and economic factors
-natural and built environments
-policies and programs
4. HR-QOL and well being
-wellbeing/satisfaction
-physical, mental, and social health-related WOL
-participation in common activities
Primary health care - correct answer -PHC is the provision of
integrated, accessible healthcare services by clinicians who are
accountable for addressing a large majority of personal
healthcare needs, developing a sustained partnership with
patients, and practicing in the context of family and community
, -activities and/or functions define boundaries of primary care
-entry points to a system
-care that is accessible, comprehensive, coordinated, continuous
and accountable
Managed care - correct answer -a network that is integrated
and combines financing and delivery of healthcare services to
covered individuals
-connects consumers, sponsors, providers, and 3rd party payers
Objectives of managed care - correct answer -manage use and
price of healthcare delivery system
-control type, level, and frequency of treatment
-restrict level of reimbursement for services
Types of managed care plans - correct answer -HMO
-PPO
-POS
-integrated delivery systems
-accountable care organizations
Health maintenance organizations (HMO) - correct answer -
most common type
-offers preestablished benefit package: including preventive,
inpatient, and outpatient care
-HMO contracts with providers to provide care to enrollees
health policy Problem set study Exam
Questions and Correct Answers Guaranteed
Success 2023/2024
3rd party payers - correct answer
-private insurer reimbursement is contract specific per state
insurance commission
-Civilian Health and Medical Program of the US (military
personnel)
-Federal Employee health Benefit Program
Methods of payment for APRN - correct answer
1. Fee-for-service model
2. Episodic model
3. Capitation model, PPO, and HMO
Fee-for-service model - correct answer -unit of payment by visit
or procedure
-can occur with utilization review in which case payer has right
to authorize or deny payment of expensive medical interventions
(hospital admission, extra hospital days, surgery)
Episodic model - correct answer -one sum is paid for all services
delivered during a given illness
-DRG fee payment
,Professional Organization purpose and benefits - correct
answer -establish practice standards
-collective voice to promote nursing and quality of care
-monitor and influence policy and legislative initiatives
-position papers on practice issues
-disseminate information
Use or research in practice settings - correct answer -use EBP
-translate clinical evidence into practice settings and with
practice issues
-develop research-based clinical pathways
-track clinical outcomes and variances
-demonstrate quality and cost-effectiveness of care
-give structure to demonstration projections
-persuade lawmakers of NP value
-improve quality and patient outcomes
Barriers to research utilization - correct answer -time and cost
of studies
-resistance to change in work setting
-lack of rewards for using research findings
-lack of understanding or uncertainty regarding research
outcomes
Healthy People 2020 - correct answer 1. General health status
-life expectancy
,-healthy life expectancy
-physical and mental unhealthy days
-self-assessed health status
-limitation of activity
-chronic disease prevalence
-international comparisons
2. Disparities and inequality
-race/ethnicity
-gender
-SES
-LGBTQ
-geography
3. Social determinants of health
-social and economic factors
-natural and built environments
-policies and programs
4. HR-QOL and well being
-wellbeing/satisfaction
-physical, mental, and social health-related WOL
-participation in common activities
Primary health care - correct answer -PHC is the provision of
integrated, accessible healthcare services by clinicians who are
accountable for addressing a large majority of personal
healthcare needs, developing a sustained partnership with
patients, and practicing in the context of family and community
, -activities and/or functions define boundaries of primary care
-entry points to a system
-care that is accessible, comprehensive, coordinated, continuous
and accountable
Managed care - correct answer -a network that is integrated
and combines financing and delivery of healthcare services to
covered individuals
-connects consumers, sponsors, providers, and 3rd party payers
Objectives of managed care - correct answer -manage use and
price of healthcare delivery system
-control type, level, and frequency of treatment
-restrict level of reimbursement for services
Types of managed care plans - correct answer -HMO
-PPO
-POS
-integrated delivery systems
-accountable care organizations
Health maintenance organizations (HMO) - correct answer -
most common type
-offers preestablished benefit package: including preventive,
inpatient, and outpatient care
-HMO contracts with providers to provide care to enrollees
